Provider Demographics
NPI:1427107358
Name:MANRIQUE, NORMA (DC, LAC)
Entity type:Individual
Prefix:
First Name:NORMA
Middle Name:
Last Name:MANRIQUE
Suffix:
Gender:F
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10180 CULVER BLVD
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-3152
Mailing Address - Country:US
Mailing Address - Phone:310-815-1454
Mailing Address - Fax:
Practice Address - Street 1:10180 CULVER BLVD
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-3152
Practice Address - Country:US
Practice Address - Phone:310-815-1454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC22761111N00000X
CAAC2925171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered171100000XOther Service ProvidersAcupuncturist